trials that disregard patients' different pathological and clinical states' " or that include drastically different treatment arms' can hardly be expected to appeal to well informed participants.Research, planning, and audit committees should include women with breast cancer to help the other members appreciate the range of women's experience and knowledge.'3 There are so many women with breast cancer that finding ones with the type of expertise and experience appropriate to the committee's task should be easy.'4 That breast cancer is so common is not an enviable attribute, but, for understanding and working with patients' views, it is a convenient one.CHARLOTTE WILUAMSON

Many boys with Duchenne's muscular dystrophy present with global developmental delay before specific motor disabilities are noticed

In the Royal New Zealand Plunket Society's 1990-91 Cohort study, 581 of 4,286 women questioned (13.7%) had not initiated antenatal care until after the first trimester. These late attenders were more likely to be non-European or of high parity; 42.9% of Pacific Islander mothers and 28.9% of Maori mothers did not initiate antenatal care until after the first trimester. Late attenders were also more likely to be unmarried, of lower socioeconomic status, young or with lower educational attainment. The reason for delayed antenatal care needs to be investigated and mothers who are high parity and non-European need to be particularly targeted to encourage them to attend for antenatal care early.

posts that address problems of inner cities-for example, homelessness and drug misuse. We have been able to extend training based in general practice within the three year scheme when necessary.' Research by the South London Organisation of Vocational Training Schemes has shown that many registrars do not feel ready to enter general practice after vocational training (C Vaughan, personal communication). We provide a fourth year of training in the form of a vocational training associate scheme, which addresses registrars' further learning needs while giving them time to gain experience and confidence in practice. This initiative, in its second year, has also been able to support 34 local practices under stress.These changes have allowed us to recruit a full complement of high quality registrars to our schemes and increase the number of locally trained doctors becoming principals in south London. The training issues have become too complex to be solved by appending general practice training to hospital training. We look forward to the results of the evaluation of our innovations. These results will inform the debate about developing excellent training for general practice that will supply highly trained general practitioners for inner cities into the next century.